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“This is an Accepted Manuscript of an article published by Taylor & Francis in Medical Teacher on 27 September 2016, available online:

http://www.tandfonline.com/10.1080/0142159X.2016.1210114 .”

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Using a meta-ethnographic approach to explore the nature of facilitation and teaching

approaches employed in interprofessional education

Scott Reeves Ferruccio Pelone

Julie Hendry Nicholas Lock

Jayne Marshall Leontia Pillay Ruth Wood

Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, UK

Corresponding author

Professor Scott Reeves Kingston University & St George’s, University of London

St George’s Hospital, Cranmer Terrace, London, SW17 0BE, UK s.reeves@sgul.kingston.ac.uk

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Using a meta-ethnographic approach to explore the nature of facilitation and teaching

approaches employed in interprofessional education

Abstract

Background: Interprofessional facilitators and teachers are regarded as central to the effective

delivery of interprofessional education (IPE). As the IPE literature continues to expand, most

studies have focused on reporting learner outcomes, with little attention paid to IPE facilitation.

However, a number of studies have recently emerged reporting on this phenomenon.

Aim: To present a synthesis of qualitative evidence on the facilitation of IPE, using a meta-

ethnographic approach.

Methods: Electronic databases and journals were searched for the past 10 years. Of the 2,164

abstracts initially found, 94 full papers were reviewed, and subsequently 12 papers were included.

Two researchers independently completed each step in the review process. The quality of these

papers was assessed using a modified critical appraisal checklist.

Results: Seven key concepts embedded in the included studies were synthesised into three main

factors which provided an insight into the nature of IPE facilitation. Specifically, the synthesis

found that IPE facilitation is influenced by ‘contextual characteristics’; ‘facilitator experiences’ and

‘use of different facilitation strategies’.

Conclusions: IPE facilitation is a complex activity affected by contextual, experiential and

pedagogical factors. Further research is needed to explore the effects of these factors in IPE.

Keywords: Interprofessional education; Interprofessional facilitation; teaching, learning; meta-

ethnography

Introduction

Interprofessional education (IPE) is as an activity that occurs when two or more professions learn

together on an interactive basis to improve collaboration and the quality of care (Barr et al., 2005).

The rationale for the development of IPE is that learning together can enhance interprofessional

practice which, in turn, can improve the delivery of health and social care services as well as

enhance patient safety practices (Barr et al., 2005; World Health Organization, 2010).

Encouragingly, evidence for the effects of IPE has been growing over the past few years. As a

result, an increasing amount of IPE scoping and systematic reviews have synthesised the evidence

base. Collectively, these reviews have indicated that this form of education can help to nurture

interprofessional collaboration (Hammick et al., 2007; Reeves et al., 2016) and improve healthcare

outcomes in several fields such as mental health (Pauzé & Reeves 2010; Curran et al., 2012),

delirium care (Sockalingam et al., 2014), diabetes care and domestic violence management

(Reeves et al., 2013).

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While there has been a growth of IPE reviews reporting the effectiveness of this type of education

on participants’ collaborative competence and ability to deliver safe and effective care (Brandt et

al., 2014; Lawlis et al., 2014; Reeves et al., 2013, 2016; Sunguya et al., 2014), little attention has

been placed on the facilitation/teaching processes employed by individuals who deliver IPE. In

addition, while there has been a growth of qualitative IPE studies, there has been no attempt to

synthesise this type of research to assess the nature of the growing qualitative evidence base. This

paper presents the findings from a meta-ethnography that synthesised available qualitative

research to understand the nature of IPE facilitation.

Background

The role of the IPE facilitator (also referred to as teacher, mentor, preceptor, supervisor) has long

been seen as fundamental in the literature (e.g. Cleghorn & Baker 2000, Howkins & Bray 2008). IPE

facilitators are regarded as key in setting the learning climate and also creating a comfortable,

positive and collaborative learning environment (e.g. classroom, practice placement, online

learning). To date, the IPE literature has offered a series of possible attributes required for staff to

facilitate interprofessional learning in an effective manner. These include experience of

collaborative practice, conflict resolution skills, flexibility, confidence and a good sense of humour

(Holland 2002; Freeth et al., 2005; Howkins & Bray 2008). However, it has been found that most

IPE facilitators often do not have the required attributes to successfully facilitate interprofessional

collaborative learning (Reeves 2000; Steinert 2005). Consequently, Madden et al. (2006) have

recommended that a range of faculty/staff development opportunities should be provided to IPE

facilitators. While such activities can help prepare facilitators for their IPE work, it has been argued

that faculty/staff development needs to be regularly offered to maintain facilitation competence

Howkins & Bray 2008). It has also been argued that IPE facilitators need to be effective role

models for interprofessional collaboration (Selle et al., 2008). Indeed, a report by Lindblom et al.

(2007) revealed that students stressed the importance of interprofessional role modelling to help

them learn how to collaborate more effectively in clinical settings. Given the importance of the IPE

facilitator role and the growth of the IPE literature, combined with a lack of attention to

qualitative synthesis, a meta-ethnography was undertaken to synthesise available qualitative

research in the IPE literature.

Methods

Mindful of a range of methodological debates related to meta-ethnography as this approach

evolves (Atkins et al., 2008; Toye et al., 2014), the synthesis reported in this paper was framed by

an established meta-ethnographic approach (Noblit & Hare, 1988) and also applied a pre-existing

protocol (Reeves et al., 2015).

The synthesis was guided by the following objectives:

1. To synthesise the available qualitative research related to the involvement of staff who

facilitate IPE in health and social care.

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2. To investigate the potential influence of IPE contextual factors (e.g. professional mix, space

and time constraints) and teacher characteristics (e.g. expertise and attitudes, perception of

learners) on the IPE they facilitate.

3. To identify any gaps in the IPE evidence, and suggest a future agenda for research.

Inclusion criteria

For the purposes of this review, IPE was defined as an activity that occurs “when members (or

students) of two or more professions learn with, from and about one another to improve

collaboration and the quality of care” (Barr et al., 2005). Specifically, this review focused on

studies reporting the delivery of IPE by teachers (also termed facilitators, mentors, preceptors and

coaches) to learners.

Studies which met the following criteria were included in the review:

1. They were defined as an IPE study according to the definition presented above.

2. Teachers were involved in the delivery of IPE to learners from health and/or social care

backgrounds.

3. The studies were qualitative in nature, such as, phenomenological studies, ethnographic

studies, grounded theory studies or case studies (Hancock et al., 2002).

Search strategy

Nine electronic databases were systematically searched for relevant peer-reviewed papers:

Applied Social Sciences Index and Abstracts (ASSIA), British Education Index (BEI), CINAHL Plus,

EMBASE, ERIC, Healthcare Management Information Consortium (HMIC), MEDLINE and PsycINFO.

A MEDLINE search strategy was formulated in to address the review objectives and the inclusion

criteria (Reeves et al., 2015), when necessary this was adjusted to implement on other

bibliographic databases. Search results were limited to the past 10 years and to papers written in

English.

Additional papers were obtained searching the reference lists of included studies and also from

hand searching the last ten years of two journals, namely Medical Teacher and Journal of

Interprofessional Care that publish the largest number of IPE research.

Study selection

The selection process was conducted in two stages – title/abstract screening followed by full-text

paper screening. After duplicates were removed, two reviewers from the team independently

screened all titles and abstracts produced from the searches. Studies were not considered further

when their abstract or their title (when the abstract was unavailable) clearly pointed out that: (1)

the focus was not IPE; (2) the study was a systematic review, a quantitative study, a commentary

and/or had not been peer-reviewed.

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Full-text articles of any relevant titles/abstracts were obtained and screened with reasons for

exclusion added. At this stage of the screening process, one reviewer independently scanned the

reference list of the included studies for potentially eligible articles that were not identified

through the electronic searches.

Both the abstract and the full-text screening were performed in parallel by two members of the

review team working in pairs, with discrepancies resolved by a third reviewer. Furthermore, each

stage was guided by a check-list to ensure consistency among the review team in applying the

eligibility criteria.

Study selection, including reasons for exclusion, is summarised in Figure 1. In the final stage of the

selection process a total of 11 papers were excluded because they either did not focus on

facilitators’ experiences in delivering IPE (n=6) or they evaluated learners’ perceptions of IPE

facilitation (n=5) rather than focusing on the facilitators’ own perspectives as defined in the

inclusion criteria. Twelve studies (Cooper & Spencer-Dawe., 2006; Lindqvist & Reeves., 2007; Rees

& Johnson., 2007; Anderson & Thorpe., 2010; Carlson et al., 2011; Egan-Lee et al., 2011; van

Soeren et al., 2011; Chipchase et al., 2012; Clouder et al., 2012; Hanna et al., 2013; Evans et al.,

2014; Jakobsen & Hansen., 2014) met the inclusion criteria and were included in the synthesis.

INSERT FIGURE 1 ABOUT HERE

Data abstraction and synthesis

For each included study, two reviewers independently extracted the following information:

Details of study characteristics – study objectives, methodology, sample, study setting and the

year of publication;

Results information – key themes or concepts identified in the studies (distinguishing between

first and second order interpretation);

Context information – details about the IPE teaching and learning processes;

Study quality – criteria for assessing the methodological quality of included studies were based

on the Critical Appraisal Skills Programme (CASP) tool (CASP 2006). This tool was slightly

modified so that each of the items collectively provided an aggregate score which indicated

study rigor. These criteria covered issues such as, appropriateness of the research design to

address the study aims, appropriateness of sampling/recruitment procedures and

appropriateness of data collected.

The approach to synthesising the included studies (aggregating information, re-interpretion,

developing a synthesis) was informed by the approach developed by Noblit & Hare (1988), and

adapted by Britten et al. (2002). In doing so, the included papers were read and re-read by the

review team to gain a detailed understanding of their contents. From this work second order

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interpretations (i.e. original author interpretations of data) were collated to identify key concepts.

This informed a subsequent stage of analysis in which the review team’s own concepts and second

order interpretations were compared and contrasted in order to develop a series of synthesised

third-order interpretations (key factors) based on the evidence in the included papers.

Findings Summary and context of included articles

The characteristics of the 12 included studies are presented in Table 1. The geographic setting for

the studies varied with five studies from the United Kingdom, three from Canada and one each

from Australia, Denmark, Sweden and Vietnam. Within these studies IPE was delivered in a

classroom context (4 studies), a practice-based setting (2 studies), a mixture of classroom and

practice settings (2 studies), via an online methods (3 studies) or simulated learning environment

(1 study).

With regard to the facilitation approach employed, most of the studies described IPE activities co-

led by two facilitators (Cooper & Spencer-Dawe., 2006; Jakobsen & Hansen., 2014; Hanna et al.,

2013; Anderson & Thorpe., 2010; van Soeren et al., 2011) or single facilitators (Lindqvist &

Reeves., 2007; Carlson et al., 2011; Egan-Lee et al., 2011; Evans et al., 2014; Rees & Johnson.,

2007). Clouder et al., (2012) in contrast, reported on the experiences of peer facilitators in an

online IPE context, while one study was focused on the role of the clinical supervisor in facilitating

IPE in practice placements (Chipchase et al., 2012).

The number of facilitators involved in the included studies ranged from four (Chipchase et al.,

2012) to 58 (Anderson & Thorpe., 2010). The facilitators were from a range of professional

backgrounds, including, nursing (6 studies), physiotherapy (5 studies), occupational therapy (4

studies), medicine and social work (3 studies) and speech pathology (2 studies).

INSERT TABLE 1 ABOUT HERE

Study methods and quality appraisal

The 12 qualitative studies included in this review, involved six case studies, three phenomenology

studies, one ethnography, one participatory action research study as well as a study that described

employing a ‘qualitative approach’ (see Table 1). A variety of methods were used to collect study

data. Focus groups were most common used (Anderson & Thorpe, 2010; Carlson et al., 2011;

Chipchase et al., 2012; Cooper & Spencer-Dawe., 2006; Hanna et al., 2013; Jakobsen & Hansen,

2014; Lindqvist & Reeves, 2007; Rees & Johnson, 2007; van Soeren et al., 2011), followed by

individual interviews (Anderson & Thorpe, 2010; Carlson et al., 2011; Chipchase et al., 2012;

Cooper & Spencer-Dawe, 2006; Egan-Lee et al., 2011; Hanna et al., 2013; Clouder et al., 2012;

Rees & Johnson, 2007), observations (Carlson et al., 2011; Hanna et al., 2013; van Soeren et al.,

2011), written reflections (Cooper & Spencer-Dawe, 2006; Jakobsen & Hansen, 2014; Clouder et

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al., 2012) and telephone interviews (Evans et al., 2014; Lindqvist & Reeves, 2007). In general,

most studies gathered two or more types of qualitative data (Table 1).

In terms of methodological quality, all studies clearly described the research question, the

methods of data collection and analysis (see Table 2). Only three studies considered researcher

reflexivity (Carlson et al., 2011; Egan-Lee et al., 2011; Rees & Johnson, 2007). Most of the studies

failed to provide any information on the sampling strategy (Clouder et al., 2012); those that did

generally used a simple convenience sample (Chipchase et al., 2012; Cooper & Spencer-Dawe,

2006; Jakobsen & Hansen, 2014; Rees & Johnson., 2007; van Soeren et al., 2011). Based on the

modified critical appraisal tool (CASP 2006), it was found that the included studies were generally

robust in nature.

INSERT TABLE 2 ABOUT HERE

Key findings from the synthesis

The synthesis generated seven key concepts which were linked to the second order interpretation

embedded in the 12 selected studies. These concepts were synthesised into three main factors

(third-order interpretations). As a result of this synthesis, IPE facilitation was found to be mainly

influenced by the following factors: contextual characteristics; facilitator experiences and use of

different facilitation strategies (See Table 3). Below, details are provided relating to how these

three factors affect the nature of IPE facilitation.

INSERT TABLE 3 ABOUT HERE

In relation to the ‘contextual characteristics’ factor, the synthesis revealed that

logistical/organisational and information technology issues contributed to facilitators’ ability to

facilitate IPE. In terms of logistical/organisational issues, the synthesis indicated that IPE

facilitation was an additional activity which needed to be managed on top of facilitators’ normal

profession-specific workloads. However, for facilitators engaged with interprofessional e-learning

the asynchronous aspect of their role ensured flexibility as it could be fitted around profession-

specific workloads (Anderson & Thorpe, 2010; Evans et al., 2014). The synthesis also revealed that

a lack of resources and organisational support could impede facilitators’ work (Anderson &

Thorpe, 2010). In addition, large cohorts of students created difficulties for facilitators with

regards to impeding interaction between learners (Rees & Johnson, 2007). In respect of the effect

of e-learning technologies, the synthesis indicated non-verbal communication between facilitators

and learners could undermine learning processes (Hanna et al., 2013). Technical problems were

also identified as a potential issue as they impacted on the delivery mode. However it was

reported that skilled facilitators used any technological problems they encountered as a positive

learning experience to encourage students to problem solve solutions on a collaborative basis

(Evans et al., 2014).

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The following three issues, facilitator preparation and support, collaborating and co-facilitating

and using IPE facilitation as a professional development opportunity, contributed to the ‘facilitator

experiences’ factor. It was found that initial preparation and on-going support for facilitators was

required in order to meet the demands of this complex role (Rees & Johnson, 2007, Lindqvist &

Reeves, 2007, Evans et al., 2014; Egan-Lee et al., 2011). Furthermore, it was reported that regular

opportunities should be offered for facilitators to share knowledge, experiences and ideas (Rees &

Johnson., 2007, Lindqvist & Reeves, 2007). With regards to the second issue, it was found that co-

facilitation was key to developing collaboration between IPE facilitators (Hanna et al., 2013) and

regular planning and discussion between facilitators could promote formal and informal

collaboration (Jakobsen & Hansen., 2014). Co-facilitation could ensure learners’ different

professional experiences could be connected which in turn offered more learning opportunities

(van Soeren et al., 2011). Where a more experienced IPE facilitator supported a new facilitator, co-

facilitation was regarded as effective in providing direct learning experiences for a neophyte

(Egan-Lee et al., 2011). It was also reported that service users who co-facilitated IPE along with

professional facilitators could provide positive, enjoyable and valuable IPE experiences for

students (Cooper & Spencer-Dawe., 2006). The use of IPE facilitation as a professional

development opportunity was found to be an important element as it allowed facilitators to

enhance their interprofessional facilitation knowledge and skills (Egan-Lee et al 2011; Clouder et

al., 2012; Evans et al., 2014). Engagement in IPE also provided facilitators with opportunities to

form new relationships with colleagues and students from other professions which could further

promote their knowledge of each other’s roles (Anderson & Thorpe., 2010) as well as offer

opportunities to consider changes to their own clinical and professional practice (Cooper &

Spencer-Dawe, 2006).

In relation to the ‘different facilitation strategies’ factor, employing differing interprofessional

teaching approaches and using interprofessional approaches and experiences to enrich the

learning, contributed to facilitators’ ability to facilitate IPE. When employing differing

interprofessional teaching approaches, the synthesis identified that IPE facilitators employed a

range of facilitation techniques to encourage effective student learning. These focused on the

following: employing learner and teacher-centric approaches (van Soeren et al., 2011); using

shared reflection (Carlson et al., 2011); providing effective instruction before the IPE and offering

feedback after the learning (van Soeren et al., 2011; Clouder et al., 2012); exploring different

knowledge domains and professional responsibilities (Carlson et al., 2011); and displaying

enthusiasm, humour and empathy to help promote collaborative learning (Lindqvist & Reeves.,

2007).

Regarding the issue of using interprofessional approaches and experiences to enrich the learning, it

was found that IPE facilitators employed a number of techniques, which included, supporting

collaboration by ensuring learners took patient care decisions by mutual consent of all team

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members (Carlson et al., 2011), offering regular interprofessional briefing sessions (Chipchase et

al., 2012) and drawing on their previous experiences of interprofessional collaboration to inform

their facilitation work with learners (Lindqvist & Reeves., 2007).

Discussion

As presented above, the synthesis of the qualitative IPE facilitation literature indicated that this

type of activity is influenced by three main factors: the nature of the context in which the IPE is

delivered can either support or impede the facilitators work; the nature of the facilitators’

experiences in relation to, for example, preparation, on-going support and co-facilitation; and the

use of different facilitation strategies can enhance the nature of IPE experience for learners.

Based on these findings, one can argue that when designing future IPE experiences, curricular

developers need to be mindful of these facilitation factors in the recruitment, preparation and on-

going support of facilitators, as attention to each factor can improve the overall experience of

teaching and learning for both facilitators and leaners. Specifically, the synthesis revealed a need

for initial professional development for all new facilitators to help them cope with the complex

role of facilitating IPE. Furthermore, the use of co-facilitation (between two facilitators from

different professional backgrounds) was found as a means of enhancing the quality of

interprofessional teaching and learning. In addition, it was reported that engaging service users in

the IPE facilitation process can provide additional value to the IPE learning experience. The use of

different approaches to interprofessional teaching (e.g. offering a learner-centric approach,

providing students with opportunities for shared reflection, displaying enthusiasm, humour and

empathy) was also reported to affect the IPE learning experiences. The synthesis also identified

that interprofessional e-learning could be facilitated in ways which could provide stimulating

learning experiences, albeit was dependent on effective technology and the facilitator’s ability to

overcome the challenge in engaging all students.

As noted above, the tool used in this synthesis to assess the methodological quality of the 12

included studies (CASP 2006) revealed that this empirical work could be generally regarded as

rigorous in nature. However, the synthesis of the studies revealed that facilitation occurred in a

range of different types of learning contexts, specifically, classrooms, practice placements,

simulation and e-learning. Further research is needed to explore each of these learning contexts in

more depth to identify issues of convergence and divergence between them in order to develop a

better appreciation of the approaches IPE facilitators adopt to effectively engage with learners.

Further research is also needed to explore the nature of co-facilitation as well as the use of peer

facilitators in the classroom, the clinical supervisors’ role and service users in facilitating IPE in

practice placements. In addition, as most of the included studies relied on self-report data in the

form of interviews or focus groups (data that generate perceptions about facilitation practices

rather than actual practices) more effort is needed to undertake observational studies of IPE

facilitation. In doing so, one can generate studies that provide directly observed accounts of the

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nature of facilitators’ work which would form a rigorous evidence base from which to improve IPE

facilitation practice. Finally, as the IPE facilitation literature grows, it is recommended that an

update of this synthesis is undertaken to understand how newer research into IPE facilitation

complements the findings reported in this paper, or provides new insights into the nature of IPE

facilitation.

There are a number of strengths related to this synthesis. These include: the prospective

registration with the Prospero review database (Reeves et al., 2015), the use of an established

approach to undertaking meta-ethnographic work (Noblit & Hare., 1988; Britten et al., 2002); a

broad search covering eight electronic databases as well as journal hand searches and search of

the reference lists of included papers. As a result, this review has provided a comprehensive

account of qualitative research into IPE facilitation. Nevertheless, while best practices for

reviewing and synthesising qualitative evidence were employed, there are inevitably limitations in

this work. The search was limited by excluding the grey literature and including studies only

published in English. As a result, a small number of potential studies may have been missed. In

addition, only studies published in the past 10 years were included in this synthesis, excluding the

findings from any earlier work. It is also acknowledged that there a more general bias within the

literature for publishing research that reports positive results which can mean that IPE facilitation

studies reporting more negative findings may struggle for publication.

Concluding comments

This synthesis of 12 qualitative studies of IPE facilitation indicated seven key concepts linked to

second-order interpretations that were embedded in this work. These concepts were synthesised

into three third-order interpretations which suggested that IPE facilitation is influenced by

contextual characteristics, facilitator experiences and use of different facilitation strategies. In

undertaking this synthesis it is anticipated that this review will help those responsible for

developing and implementing IPE activities to make informed judgements in the use of facilitation

approaches and techniques. In addition, this synthesis may provide useful information to

staff/faculty developers in terms of possible identifying areas where professional development for

both new and experienced IPE facilitators could be targeted.

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application to developing countries: a systematic review. PLoS One; 9(5):e96724.

Toye F, Seers K, Allcock N, Briggs M, Carr E, Barker K. 2014. Meta-ethnography 25 years on:

challenges and insights for synthesising a large number of qualitative studies. BMC Med Res

Methodol; 14:80.

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van Soeren M, Devlin-Cop S, MacMillan K, Baker L, Egan-Lee E, Reeves S. Simulated

interprofessional education: An analysis of teaching and learning processes. J Interprof Care .

2011;25(6):434-40.

World Health Organization. 2010. Framework for Action on Interprofessional Education and

Collaborative Practice. Geneva, Switzerland: World Health Organization.

1

Figure 1 - Study identification flow chart

Studies included in

Meta-ethnography

(n = 12)

Studies included in data

collection

(n = 23)

Articles excluded on full text

review (n =71): Not intervention (n=39)

Not study design (n=21)

Not participants (n=11)

Full-text articles assessed

for eligibility

(n = 94)

Articles excluded on data collection

and quality appraisal (n =11): Not focusing on facilitators

experience of delivering IPE (n=6)

Main focus on students/learners

perceptions of facilitation (n=5)

Records excluded (n = 2070) Records screened

(n = 2164)

Additional records identified

through other sources

(n = 3)

Records after duplicates

removed

(n = 2164)

Records identified through

database searching

(n = 2821)

Table 1: Study characteristics

Intervention

Aim(s)/research question(s)

Methods

Participants type (number)

Country Study IPE type

Facilitator approach

Study design Methods of data

collection

Classroom based

Single facilitator

“To investigate what key factors facilitators perceive as important in allowing them to support the IPL process

in an effective manner” (p 403)

Single case study

Focus group, Telephone interviews

Medicine, nursing, speech and language therapy, occupational

therapy and physiotherapy (Total = 13)

UK Lindqvist &

Reeves, 2007

Single facilitator

“To establish an infrastructure for IPE and rigorously evaluate both its outcomes and the process by which

such outcomes had transpired” (p 503) Phenomenology

Focus group, Individual interviews

‘Allied Health’ (6); Nursing(4); Policy studies (3); Maternal and

Child Health (1); Mental Health/Learning Disabilities (1)

(Total = 15)

UK Rees &

Johnston, 2007

Co-facilitation

“To investigate the involvement of service users in the delivery if IPE for undergraduate students”(p 605)

Case study

Focus group, Individual interviews,

written reflections

Not specified (Total = 7) UK

Cooper & Spencer-

Dawe, 2006

Practice based

Co-facilitation

“To evaluate whether the clinical tutors could create a safe and challenging learning environment in another

setting to that of the ITU” (p 407)

Case study Focus group,

Written reflections

Nursing (4), Physiotherapy (2), OT (2) (Total = 8)

Denmark

Jakobsen & Hansen, 2014

Clinical supervision

“To develop a detailed qualitative account of the views of medical and allied health students, and their

supervisors in the context of an interprofessional clinical placement” (p 466)

Case study Focus group,

Individual interviews

Physiotherapy (2), OT (1), Speech pathology (1) (Total = 4)

Vietnam Chipchase et

al., 2012

Single facilitator

“To describe how nurses act when facilitating interprofessional student teams at a clinical training

ward” (p 310) Ethnography

Focus group, Individual interviews,

Observations

Nursing (Total = 8) Sweden Carlson et al.,

2011

Classroom and

Practice based

Single facilitator

To provide “...insight into their [neophyte facilitators] perceptions and experiences in preparing for and

delivering IPE” (p 333)

Multiple case study

Individual interviews

Nursing (8), Dietetics (3), Medicine (3), OT (3),

Physiotherapy (3), Social work (3) (Total = 21)

Canada Egan-Lee et

al., 2011

Co-facilitation

“To explore the impact of leading an IPE curriculum on teachers, who were at the forefront of establishing a

new IPE curriculum ...” p 492) Phenomenology

Focus group, Individual interviews

Not specified (Total = 58) UK

Anderson & Thorpe, 2010

Online Single

facilitator

“To explore the facilitators’ experience of online asynchronous and synchronous IPE facilitation of pre-

licensure students” (p 1052) Phenomenology Individual interviews

Dietetics, Medicine, Nursing, OT, Physiotherapy, Social work, Speech pathology

Australia Evans et al.,

2014

(Total = 19)

Co-facilitation

“What is the experience of IPE facilitators in the online environment and what supports are most useful”

(p 299) Case study

Focus group, Individual interviews,

Observations

Nursing (2), Dental Hygiene (1), Medicine (1), Pharmacy (1),

Physiotherapy (1), Social work (1) (Total = 7)

Canada Hanna et al.,

2013

Peer facilitation

“..To explore the range of cognitive, personal and instrumental gains for peer facilitators in the online

IPLP...” (p 461)

Participatory action research

Individual interviews, written reflections

Not specified (Total = 8) UK Clouder et al.,

2012

Simulation Co-

facilitation

To examine “the nature and complexity of interprofessional processes as they are undertaken

within a simulated learning context” (p 433) Case study

Observations, Focus group

Lead facilitators (2), Clinical site facilitators (7)

(Total = 9) Canada

van Soeren et al., 2011

Table 2: Quality criteria and results

Quality criteria

An

der

son

&

Tho

rpe

20

11

Car

lso

n e

t al

., 2

01

1

Ch

ipch

ase

et

al. 2

01

2

Co

op

er &

Sp

ence

r-D

awe

20

06

Egan

-Lee

et

al. 2

01

1

Evan

s et

al.

20

14

Han

na

et a

l.

20

13

Jako

bse

n &

H

anse

n 2

01

1

Lin

dq

vist

&

Ree

ves

20

07

Clo

ud

er e

t al

. 20

12

Ree

s &

Jo

hn

sto

n

20

07

van

So

eren

et

al.

20

11

1 Was there a clear statement of the aims of the research?

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

2 Is a qualitative methodology appropriate? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

3 Was the research design appropriate to address the aims of the research?

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

4 Was the recruitment strategy appropriate to the aims of the research?

Yes Yes Not

clear Not

clear Yes Yes Yes

Not clear

Yes No Not

clear Not

clear

5 Was the data collected in a way that addressed the research issue?

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

6 Has the relationship between researcher and participants been adequately considered?

No Yes No No Yes Not

clear Not

clear Not

clear No

Not clear

Yes No

7 Have ethical issues been taken into consideration?

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

8 Was the data analysis sufficiently rigorous? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

9 Is there a clear statement of findings? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

10 How rigorous is the research? + + + + + + + + + + + + + + + + + +

Note: + + = ‘high rigor’; + = ‘good rigor’

Table 3: Key synthesis findings

Concepts Second order interpretations

Third order interpretations

Logistical and organisational issues that affect facilitators’ work

"Many educators were teaching over and above their allotted timetables and a lack of resources and support with operational issues was evident" (Anderson & Thorpe., 2010; p. 499).

Some facilitators were working in part-time or full-time clinical positions and were able to undertake their facilitation role outside of their normal working hours" (Evans et al., 2014; p. 1054).

"[large cohorts of students] create significant difficulties which impact on staff engagement with IPE" (Rees & Johnson., 2007; p. 552).

"Facilitators enjoyed the flexibility of the facilitation role and more specifically, the fact that the asynchronous aspect of their role could be fitted around other important aspects of their lives (Evans et al., 2014; p. 1054).

The effect of contextual characteristics on facilitation

The influence of technology on facilitation

"Even when technology worked smoothly, facilitators were acutely aware of the huge reduction in the non-verbal cues facilitators and participants use to communicate" (Hanna et al., 2013; p. 300).

"Several facilitators described using the technological problems as a learning experience for the students. These facilitators talked about encouraging their student teams to problem solve solutions as to how they might involve team members that were having technological difficulties" (Evans et al., 2014; p. 1054).

"Technological problems in the synchronous environment over time"; "Delayed group formation appeared to be associated with reduced interprofessional collaboration" (Hanna et al., 2013; p. 301).

"Facilitators also mentioned that at times it was difficult to engage some students in the synchronous environment due to a lack of body language cues that are present in the face to face environment". (Evans et al., 2014; p. 1055).

The need for preparation and support

“Existing staff development opportunities must be well planned and publicised in order to reassure facilitators and those contemplating the role, that adequate support is available and that opportunities exist for sharing knowledge, experiences and ideas" (Rees and Johnson., 2007; p. 553).

"It was felt that the induction allowed facilitators to learn the basic principles of IPL" (Lindqvist & Reeves., 2007; p. 404).

"As many of the facilitators had limited experience […] they emphasized the overall importance of facilitator support" (Evans et al., 2014; p. 1054).

"The [interprofessional] competencies of the clinical tutors must be continually trained and maintained (Jakobsen & Hansen., 2014; p. 411).

"An important factor to consider in the preparation of IPE facilitators is an understanding of the complexities of facilitating different groups of professions due to heterogeneous learning needs as well as histories of interprofessional friction and issues relating to imbalances of power, status and authority" (Egan-Lee et al., 2011; p. 337).

"It was felt that the weekly de-briefing sessions encouraged the facilitators to share experiences and obtain support from one another" (Lindqvist & Reeves., 2007; p. 404).

How facilitator experience influence their facilitation work

Collaborating and co-facilitating

"Analysis of the data supported the enhanced value of co-facilitation to enable collaborative online learning in IPE" (Hanna et al., 2013; p. 301).

"The presence of more than one facilitator from different professional backgrounds helped connect different learners’ experiences [and] capture more learning opportunities" (van Soeren et al., 2011; p. 438).

"Forms of support could include co-facilitation opportunities for neophyte and experienced IPE facilitators. In such instances, new facilitators would have the opportunity to observe, mirror facilitation styles, and receive feedback" (Egan-Lee et al., 2011; p. 355).

"For many educators team-teaching, or paired facilitation, enabled the observation of colleagues while teaching". (Anderson & Thorpe., 2010; p. 497).

"All the facilitators had found the experience of working with service users [as co-facilitators] positive and enjoyable, acknowledging the educational value of the programme" (Cooper and Spencer-Dawe., 2006; p. 611).

"A positive side effect of common planning and collaboration was that the tutors got to know each other better individually and professionally, thus enhancing future formal and informal collaboration concerning students’ clinical learning" (Jakobsen & Hansen., 2014; p. 410).

IPE facilitation as a professional development opportunity

"The facilitators saw the [facilitation] experience as an opportunity for their development of skills as a facilitator of learning, as an IPE facilitator and as an online facilitator" (Evans et al., 2014; p. 1053).

"Facilitators acknowledged increased understanding of other professions [they] developed skills in organisation, communication, teaching, diplomacy, conflict resolution" (Clouder et al., 2012; p. 462).

"Many facilitators noted that their facilitation experiences contributed to improvements in their knowledge of interprofessional concepts and approaches" (Egan-Lee et al., 2011; p. 336).

"Leading the IPE curriculum had brought these educators together in the design and delivery of the curriculum and this has enabled them to further their knowledge of each other’s professions" (Anderson & Thorpe., 2010; p. 496).

"On a personal level, facilitators felt they had gained a valuable learning experience from working with service users in delivering IPE. Following their experiences, they described a number of changes they had made to their own clinical and professional practice to make service users more central to their work" (Cooper & Spencer-Dawe., 2006; p. 612).

“Perceiving that the students were learning was personally satisfying for the facilitators, as they felt they had assisted that process through their facilitating roles” (Evans et al., 2014; p. 1053).

"The opportunity to form new relationships with colleagues and students from other disciplines [was a key benefit of IPE facilitation]. In particular the associations with other professional colleagues had enhanced [facilitators’ own] practice" (Anderson & Thorpe., 2010; p. 498).

Employing differing approaches to interprofessional teaching

"Facilitators adopted one of two contrasting approaches which contributed to how they facilitated the debrief session. One approach seemed more ‘learner-centric’, while the other approach appeared to be more ‘teacher-centric’ in nature. These differing approaches resulted in contrasting types of interprofessional discussion amongst the learners" (van Soeren et al., 2011; p. 438).

Facilitators employed "a reflective approach [...] as a conscious educational strategy with the intention to let students explore

Need to use a range of strategies for effective facilitation

and learn (Carlson et al., 2011; p. 312).

To be effective in their IPL role, facilitators felt that they needed to display a range of [collaborative] attributes such as enthusiasm, humour and empathy (Lindqvist & Reeves., 2007; p. 404).

"Facilitators highlighted the importance of feedback from their students in consolidating their sense of self as professionals, supporting the notion that [inter]professional identity formation is intersubjective, dialogical and relational in nature" (Clouder et al., 2012; p. 463).

"Facilitators should be prepared to minimize the effect of these negative emotions [feelings of fear of failure, and feeling unsafe] by increasing familiarity among participants. Providing ample instruction about what will happen during the simulation and gradual introduction of role-play [...] may create a more comfortable and safe learning climate" (van Soeren et al., 2011; p. 439).

In "breaking down [hierarchical] barriers [facilitators needed to make] the different knowledge domains and professional responsibilities visible and understandable to students" (Carlson et al., 2011; p. 312).

Using interprofessional approaches and experiences to enrich the learning

"Most facilitators attempted to infuse their IPL work with the range of important [collaborative] attributes they identified” (Lindqvist & Reeves., 2007; p. 404).

“[Facilitators supported] team work by constantly reminding the students that all decisions regarding patient care had to be decided mutually by the team" (Carlson et al., 2011; p. 312).

Facilitators need to "set up regular interprofessional briefing sessions that focused on clinical and collaborative aspects of their practice" (Chipchase et al., 2012; p. 468).

"Facilitators felt that their previous experiences of […] collaborating in health care teams were helpful to draw upon and inform their work with their student groups" (Lindqvist & Reeves., 2007; p. 404).

"Facilitating interprofessional understanding [...] it was important for students to understand their own profession as well as that of the other team members" (Carlson et al., 2011; p. 311).

"To stimulate enthusiasm and motivation to learn, the burden falls on facilitators to make learners aware of manageable gaps in their knowledge and at the same time heighten the practical relevance [linked to interprofessional collaboration] of the learning experience" (van Soeren et al., 2011; p. 438).

"Facilitators felt that exposing students to one another in small learning groups provided them with a better knowledge of teamwork and also helped improve their interprofessional relationships" (Lindqvist & Reeves., 2007; p. 404).